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Turned eyes (squint)

squint; turn; eye; eyes; crossed; wall; strabismus; lazy; amblyopia; turned;

When both eyes are lined up, the brain is able to merge the two pictures into a single, three dimensional picture which allows us to see the position of objects in relation to each other (depth perception). When the eyes look in different directions, the brain has to ignore one eye to be able to see clearly. When a child has a squint, the eyes do not look in the same direction some of the time, or all of the time.

Contents


What is a turned eye (squint)?

  • A turned eye is when one eye does not look in the same direction as the other.
  • One eye may turn in towards the nose (crossed eyes) or outwards towards the ears (wall eyes), or up or down.
  • This is also known as a squint.
  • The medical name for this is strabismus.

Normal development

  • In the first few weeks, a baby's eyes often cross, or wander in different directions some of the time.
  • By the age of 3 months the eyes should be lined up so that they both look at the same object.
  • If a young baby's eyes are turned in or out most of the time, or if a baby over 3 months old has turned eyes, the baby needs to have his eyes checked.
  • Some babies and young children have turned eyes some of the time (more often when they are tired or unwell). These babies should also have their eyes checked.

When does it occur?

  • About 2% to 4% of children will have a turned eye.
  • About half of these children will have a turned eye from birth, and about half develop it at a later age, sometimes because one eye sees more clearly than the other, or because of an injury to the eye or some (fairly rare) illnesses.

Who is most at risk?

  • Children are more likely to have a turned eye if there are other people in their family who also have a turned eye (there are some genetic factors).
  • Children with developmental problems such as cerebral palsy are more likely to have a turned eye.
  • Often the condition will occur without any apparent reason.

What to look for

  • One eye may be obviously turned in, or out, or up or down compared to the other.
  • You may be able to see that your baby's eyes do not move together, or that one is not lined up with the other.
    • This may be easier to see in a photograph where a flash has been used, because the reflection of the light from the flash will be in a different position on the iris in each eye. The reflection may be closer to the nose on one side than the other, or higher on one side than the other.
    • This difference in position of the light reflection can often also be seen when there is a bright light several metres from the baby (such as a room light).

Older children may:

  • close or cover one eye to try to see more clearly
  • tilt or turn their head
  • have difficulty judging distances
  • not be very well coordinated
  • have headaches or tired eyes
  • have difficulty in reading
  • blink a lot
  • have poor concentration.

Children who have always had a turned eye may not know that they have an eye problem (after all, it has always been the same for them), but if the squint 'comes and goes', they may be aware of having blurred or double vision some of the time.

Treatment started early will produce the best result. If you think your baby or young child may have a vision problem (including a squint), see your doctor soon.

Some babies may appear to have a squint when they don't have one. There can be a wide fold of skin near the inner side of the eyes, or a broad, flat nose which can give the appearance of the eyes looking in different directions. The reflection of a light (or a flash in a photo) will show that the eyes are lined up. However, if you think that your child has a squint, get your baby's eyes checked. This 'false strabismus' should disappear as your child gets older.

Problems caused by a turned eye

  • The brain normally gets two very similar 'pictures', one from each eye, but if a child has a turned eye, the 'pictures' from the eyes will be different.
    • The brain will not be able to merge these different 'pictures' together, so it will 'ignore' one of the pictures.
    • If the 'picture' from one eye is always ignored, vision in that eye will become weaker, and the child may become blind in that eye, even when there is no damage to the eye. This is called a 'lazy eye' or amblyopia.
    • Having poor vision in one, or both eyes to start with can also cause a turned eye, as the 'picture' from the weaker eye is 'ignored'.
  • Most people who have a turned eye can manage with very few problems, but:
    • they may have difficulties with judging distances,
    • and there may be some prejudice about having a turned eye. People usually look at someone with whom they are interacting, and they may find this harder to do if they are not sure whether the other person is looking at them or not.
    • and if the person has good vision in only one eye, there is an increased risk of blindness if the good eye gets injured.

Who can help?

If you think that your child has a turned eye, see your doctor, as your child may need to be referred to an ophthalmologist (specialist eye doctor)

Treatment

A squint does not go away as a child gets older, and it will not get better if it is not treated.

Treatment aims to:

  • preserve vision (keep both eyes working well)
  • make the eyes work together
  • straighten the eyes.

Treatment may include

  • glasses (this may be enough, so that each eye can see clearly)
  • patching one eye (the good eye is patched so that the brain takes more notice of the image from the other eye)
  • eye exercises (to get the eyes working together better)
  • surgical correction (operating on some of the muscles that control eye movement).  Newer techniques using Botulinum toxin (botox) injections into muscles around the eye can also be effective.

If left untreated, a squint may lead to permanent loss of vision in one eye.

References

Orthoptic Association of Australia Inc. Pamphlet 'Turned eyes in children: understanding strabismus' 

Raising Children Network 
http://raisingchildren.net.au/ 

Medline Plus - National Libraries of Medicine USA 
http://www.nlm.nih.gov/medlineplus

Nemours Foundation - KidsHealth.org
http://kidshealth.org

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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